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Objective Our study completes the development and estimates the psychometric properties of a novel, ventral hernia-specific patient reported outcomes (PRO) tool-the Abdominal Hernia-Q (AHQ). Summary background data A standardized method for measuring hernia-related PRO has not been identified. There remains a need for a broadly applicable, hernia-specific tool that incorporates patient viewpoints and offers pre- and postoperative forms. Methods Concept elicitation interviews, focus groups, and cognitive debriefing interviews were completed to define content. The preoperative AHQ was administered to patients scheduled to have a ventral hernia repair (VHR). The postoperative AHQ was administered to patients within 24 months post-VHR. The SF-12 and HerQLes were concurrently administered. Psychometric evaluation was performed. Subsequently, the AHQ (pre: 8 items; post: 16 items) underwent prospective testing. Results Cross-sectional evaluations of patient responses to the AHQ (pre n = 104; post n = 261) demonstrated high internal consistency (Cronbach α pre = 0.86; post = 0.90) and moderate disattenuated correlations with the HerQLes (pre r = -0.71 and post r = -0.70) and the SF-12 domains (pre and post r ≥ 0.5 for 7 of 8 domains). Principal components analyses produced 2 factors preoperatively and 3 factors postoperatively. In prospective testing (n = 67), the AHQ scores replicated the cross-sectional psychometric results and suggested sensitivity to clinical outcomes. Conclusions Through patient involvement and rigorous, iterative psychometric evaluation, we have produced substantial data to suggest the validity and reliability of AHQ scores in measuring hernia-specific PRO. The AHQ advances the clinical management and treatment of patients with abdominal hernias by providing a more complete understanding of patient-defined outcomes.

Background Aesthetic surgery is a personal choice that appeals to a wide population of individuals. The authors investigated how race and ethnicity, age, gender, income, and education level affect patient motivation to pursue cosmetic surgery and selection of a plastic surgeon. Methods One hundred seventy-two consecutive patients from two surgeons (an African American man and a Caucasian woman) completed surveys from 2016 to 2017 that assessed their decision to pursue cosmetic surgery. Univariable cumulative logit models with odds ratios and 95 percent confidence intervals were calculated with the survey data. Results African American patients were more likely to be willing to travel greater than 100 miles for a surgeon who shared the same ethnicity or race, to consider international surgery, to report that social standards did not influence their decision for surgery, and to view the buttocks as the female feature that best defines attractiveness within their race or ethnicity. Patients with incomes over $125,000 and those over the age of 50 years were more likely to seek a surgeon of the same gender, think a same-gender surgeon could provide better results, be influenced by societal standards to pursue surgery, and view the face as the defining attractive female feature within their race or ethnicity. Patients with college or graduate degrees were more likely to believe a gender- and racially concordant surgeon would provide them with better a result and believed societal standards were unrealistic to obtain with diet and exercise. Conclusions Plastic surgeons encounter patients of varying demographics, all of whom have differing perspectives about cosmetic surgery and motivations for its pursuit. Recognizing and defining these differences could enable surgeons to provide a more individualized cosmetic experience and inform future marketing strategies to attract a diverse patient population.

Due to the increased prevalence of overweight patients with ventral hernia, abdominal wall reconstruction combining ventral hernia repair (VHR) with panniculectomy (VHR-PAN) in overweight patients is increasingly considered. We present a retrospective comparison between VHR-PAN and VHR alone in overweight patients by examining costs, clinical outcomes, and quality of life (QoL). Patients with body mass index (BMI) > 25.0 kg/m2 underwent VHR-PAN or VHR alone between September 2015 and May 2017 with a single surgeon and were matched into cohorts by BMI and age (n = 24 in each cohort). QoL was assessed using the Hernia-related Quality of Life Survey (HerQLes). Cost was assessed using billing data. Statistical analyses were performed using Fisher’s exact tests, Mann–Whitney U tests, and regression modeling. Hernia defect size (p = 0.127), operative time (p = 0.140), mesh placement (p = 0.357), and recurrence rates (p = 0.156) did not vary significantly between cohorts at average follow up of one year. 60% of patients completed QoL surveys, with 61% net improvement in VHR-PAN postoperatively (p = 0.042) vs 36% in VHR alone (p = 0.054). Mean total hospitalization costs were higher for VHR alone (p = 0.019). Regression modeling showed no significant independent contribution of procedure performed due to differences in cost, wound complications, or hernia recurrence. At mean follow up of 2 years, VHR-PAN patients reported a comparable increase in QoL to those who received VHR alone without significantly different cost and complication rates. Concurrent VHR-PAN may therefore be a safe approach for overweight patients presenting with hernia and excess abdominal skin.

Background: After mastectomy, women of color undergo breast reconstruction at disproportionately lower rates than their Caucasian counterparts. In this study we address health literacy, a modifiable contributor to this disparity, through community engagement. Methods: In collaboration with a large church in West Philadelphia PA, the Abramson Cancer Center, the division of plastic surgery at the University of Pennsylvania, and with funding from the Plastic Surgery Foundation, the authors developed a health awareness symposium centered on breast reconstruction. This program, targeting women of color, included lectures, patient testimonials and a Q&A session. Participants completed pre and post-symposium surveys focusing on the availability, timing and options for breast reconstruction. Results: A total of 63 community members attended the symposium. Participants were mostly female (88.9%) and of African American descent (87.3%). Half were current breast cancer patients while 24% identified as family members/friends of a breast cancer patient. Prior to the session, 12.7% of participants were unaware of breast reconstruction as a treatment option after mastectomy, while 42.8% were unaware of insurance coverage for breast reconstruction and contralateral balancing procedures. There were statistically significant increases in the number of participants responding correctly to questions regarding insurance coverage, timing of reconstruction, and reconstruction options after the program as compared to before. Conclusions: The etiology of the existing disparity in breast reconstruction is complex and multifactorial. Partnerships between community groups and healthcare professionals from plastic surgery and breast surgery to create targeted interventions can improve community awareness in an effort to alleviate the current disparity.

Introduction Mohs surgery and reconstruction has enabled tissue-preserving resection of cutaneous malignancies. The goal of our case series evaluation is to present reconstructive techniques and functional outcomes in patients undergoing digit-sparing treatment for primary melanoma. Materials and Methods A chart review was performed to identify consecutive patients undergoing Mohs surgery and reconstruction for melanoma of the digits. Quality of life (QOL) survey was performed to assess function after the procedure. Results Thirty-two patients (13 hand, 19 foot, Age: 65.03 +/–17.78 years) who were undergoing Mohs surgery were identified. No recurrence was identified with an average follow-up of 16.1 months (1–95 months). The average defect size was 5.79 +/–4.54 cm 2. Reconstruction was performed 0–4 days after resection. The most common techniques included full-thickness skin graft (FTSG) (N = 7), collagen matrix + FTSG (N = 4), and volar advancement flap (N = 7). The reconstructive technique choice appears correlated with defect size (p = 0.0125). Neuro-QOL upper extremity survey results showed a difference that approached statistical significance between patients who underwent digit-sparing treatment (n = 7) versus direct to amputation controls (n = 5) (p = 0.072). No survey differences between digit-sparing treatment (n = 10) and amputation (n = 8) were identified in the lower extremity (p = 0.61). Conclusion Our results show digit-sparing treatment can confirm clear surgical margins and a trend toward improvement in upper extremity function compared with immediate amputation.

The purpose of this study was to assess the feasibility of acoustic radiation force impulse shear wave velocity and textural features for characterizing abdominal wall musculature and to identify subject-related and technique-related factors that can potentially affect measurements. Median shear wave velocity measurements for the right external abdominal oblique were the same (1.89 ± 0.16 m/s) for both the active group (healthy volunteers with active lifestyles) and the control group (age and body mass index-matched volunteers from an ongoing hernia study). When corrected for thickness, the ratio of right external abdominal oblique shear wave velocity -to-muscle thickness was significantly higher in the control group than in the active volunteers (4.33 s-1 versus 2.88 s-1; p value 0.006). From the textural features studied for right external abdominal oblique, 8 features were found to be statistically different between the active and control groups. In conclusion, shear wave velocity is a feasible and reliable technique to evaluate the stiffness of the abdominal wall musculature. Sonographic texture features add additional characterization of abdominal wall musculature.

Current hernia patient-reported outcome (PRO) measures were developed without patient input, greatly impairing their content validity. The purpose of this study was to develop a conceptual model for PRO measures for ventral hernia (VH) patients. Fifteen semi-structured, concept elicitation interviews and two focus groups employing nominal group technique were conducted with VH patients. Patients were recruited between November 2015 and July 2016 over the telephone from a five-surgeon patient cohort at our institution. Iterative thematic analysis identified domains. Reliability and validation were achieved using inter-rater reliability checks and triangulation. Seven framework domains were established: (1) expectations; (2) self and others; (3) surgeon and surgical team; (4) sensation; (5) function; (6) appearance; and (7) overall satisfaction. Overall patient satisfaction was associated with two themes: (1) provider–patient relationship; and (2) patient assessment of post-repair improvement. VH patients experience a profoundly broad range of reactions to VH repair. A patient-informed PRO instrument that addresses the spectrum of patient-identified outcomes can guide practice, optimizing care targeting VH patients’ needs.

Incisional and parastomal hernias are a cause of significant morbidity and have a substantial effect on quality of life and economic costs for patients and hospital systems. Although many aspects of abdominal hernias are understood, prevention is a feature that is still being realized. This article reviews the current literature and determines the utility of prophylactic mesh placement in prevention of incisional and parastomal hernias.

The authors hypothesize that posterior sheath reconstruction to achieve retromuscular mesh placement provides outcomes comparable to traditional retromuscular mesh placement and superior to intraperitoneal repair.Patients were divided into three groups: (1) retromuscular mesh placement with repaired posterior sheath defects, (2) retromuscular repair with an intact posterior sheath, and (3) intraperitoneal repair. Primary outcomes included recurrence, surgical-site occurrences, and cost.Overall, 179 patients were included. Posterior sheath defects were repaired primarily with absorbable suture or biological mesh. Recurrence rates differed significantly between standard retromuscular repair and intraperitoneal repair groups (p0.009), trended toward significance between repaired posterior sheath and intraperitoneal repair groups (p0.058), and showed no difference between repaired posterior sheath and standard retromuscular repair (p0.608). Retromuscular repair was clinically protective and cost-effective.This analysis of posterior sheath reconstruction suggests outcomes comparable to traditional retromuscular repair and a trend toward superiority compared with intraperitoneal repair. Achieving retromuscular closure appears to demonstrate clinical and cost efficacy.Therapeutic, III.

Background Prophylactic mesh placement (PMP) at the time of open abdominal surgery has gained momentum over the last decade. However, there remains an identifiable gap in the literature regarding patient-reported outcomes and qualitative metrics. In effort to gauge the population's understanding or familiarity with PMP, this study provides an educational framework and uses crowdsourcing as a novel means to assess perception among the general population. Methods A cross-sectional survey study was conducted among the general public to elicit perspectives on PMP. An online crowdsourcing platform was used to capture responses to a questionnaire. Pearson's correlation coefficients, paired t-test, chi-square test, and Fisher's exact tests were performed. Results Of 433 respondents, 338 (78.1%) were included. Individuals who had previously undergone surgery and those who had prior hernia repair were more likely to choose PMP than surgically naive patients (P = 0.06). Conclusions The majority of respondents support the use of PMP. This study contributes to the existing body of literature on PMP and serves as the first qualitative description to gauge the population's perception and understanding of this surgical technique. Within the evolving health care landscape, understanding quality-of-life measures have become increasingly important in defining successful surgical outcomes. Although the data-driven level-I evidence supports the clinical use of PMP, this study intends to establish a framework for future patient-reported outcome studies.